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The Impact Of Coaptation Reserve In Mitral Regurgitation With Transcatheter Edge-to-edge Repair
Hirotomo Sato, Joao Cavalcante, Richard Bae, Vinayak Bapat, Santiago Garcia, Mario Goessl, Go Hashimoto, Miho Fukui, Maurice Enriquez-Sarano, Paul Sorajja.
Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.

OBJECTIVE:
Although transcatheter edge-to-edge repair (TEER) is effective and safe, there is a need for better prediction of optimal outcomes. We aimed to determine predictors of optimal reduction in mitral regurgitation (MR) and survival with TEER.METHODS: We examined mitral anatomy and its change with TEER on outcomes in 154 patients (age, 83 [78, 87] years; 56% women). Coaptation reserve was defined as the distance of contiguous leaflet apposition in systole (Figure 1A). Augmentation in coaptation was measured as total amount of leaflet insertion (Figure 1B).
RESULTS:Coaptation reserve, and its augmentation were strong predictors of MR reduction (all p<0.001) (Figure 1C), as well as heart-failure hospitalization and death. For patients with either mild or no residual MR, median values for coaptation reserve, its augmentation were 3.4 (2.8, 4.4) mm, 7.2 (5.1, 9.0) mm, respectively. Receiver operator characteristic analyses determined the best values for optimal MR reduction as a coaptation reserve of >3.0 mm (p<0.001), and coaptation augmentation of ≥4.7 mm (p<0.001). These values were associated with greater 2-year survival free of all-cause mortality and persisting even in analyses restricted to those with mild or no residual MR after TEER (Figure 1D).
CONCLUSIONS:Coaptation reserve and its augmentation are simple parameters that predict optimal MR reduction and better survival in patients undergoing TEER. These findings may have implications for patient selection and expanded use of the therapy.


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